If We Apply for Nursing Home Medicaid are We Giving Up?

When working with families struggling with the sudden realization that long term nursing care is necessary for a loved one, two issues so often cause internal conflict.  One is the fear that, at $10,000 a month or more, “we’re going to run out of money”.  The other is the desire to do everything possible to bring my loved one home.  In other words, by applying for nursing home Medicaid does that mean we’re giving up on going home?

The answer is “absolutely not”.  As the cost of long term care increases and the population continues to age, two things become increasingly clear.  It is usually less expensive to receive long term care at home and most people prefer to receive their care at home.  Yet, when 24/7 care is necessary and you’ve run out of money, getting Medicaid to cover care at home has always been much harder than in a nursing home.   But that is starting to change.

In New Jersey we have several community waiver programs.  That’s what Medicaid calls programs that pay for long term care outside of a nursing home, in the community. It could be in a person’s own home or in an assisted living facility.  In 2006 then Governor Corzine signed a bill to enable Medicaid nursing home residents to return to the community  provided they are medically able to do so.  In 2009 what came to be known as the Global Options program was expanded to include several waiver programs.

So, what does this mean in plain English?  That if my spouse is in a nursing home on Medicaid he or she doesn’t have to stay there.  We must contact the nursing home social worker who will then assemble a team of nursing home staff and the resident’s family who will discuss whether and how that can be done while preserving the health and safety of the resident.

The financial eligibility requirements for Global Options are similar to those for institutional (nursing home) Medicaid although there is no option of coverage for those whose income exceeds the $2022 per month income cap.  However, Global Options can be a great option for many families struggling with the need for nursing home care now but who don’t want to give up on the possibility of bringing their loved one home at some point down the road.